6419/37 Aim21(3)

Introduction Myofascial Trigger Points (TrPs) are a common source of musculoskeletal pain presenting in primary care. General practitioners frequently refer these patients to physiotherapy departments for treatment. Identifying TrPs requires training and clinical expertise. Whilst British undergraduate medical and physiotherapy training does not include TrP identification, substantial literature and postgraduate training are available. Despite this there is evidence that TrPs causing musculoskeletal pain often go undiagnosed by both doctors and physiotherapists, leading to chronic conditions. 6-10 TrPs commonly arise from muscle overload, either as a result of acute strain/trauma, or of a more prolonged nature due to habitual postures or repetitive activities placing abnormal stresses on specific muscle groups. It is thought that if normal healing does not occur, sensitisation of peripheral nociceptors by endogenous substances becomes prolonged, leading to increased local tenderness and referred pain. Sensitisation also takes place at spinal level, where receptive fields in the dorsal horn extend and become sensitive to lesser stimuli. One hypothesis suggests that TrPs develop at motor end plates, where sensitisation of sensory and autonomic nerve endings leads to Janet Edwards physiotherapist Lancaster, UK